氨甲环酸在心肺转流下心内直视手术麻醉中的应用

Clinical efficiency of tranexamic acid in cardiac patients undergoing cardiopulmonary bypass

目的观察和评估在心肺转流手术中应用抗纤溶药氨甲环酸的疗效和安全性。方法 60例拟行心肺转流手术患者,随机分为氨甲环酸组(A组,n=30)和对照组(B组,n=30),其中A组按总量90 mg.kg-1分两次给予氨甲环酸,诱导后切皮前静注1/2量,另1/2量术中持续泵注1.0 mg.kg-1.h-1。B组给予0.9%氯化钠液9 m.lkg-1。记录两组手术前后血细胞压积(Hct)、血小板计数(P lt)、肌酐、术毕及术后24 h心包纵隔引流量和输血量,并观察过敏反应。结果与B组比较,A组术后24h心包纵隔引流量和输血量显著降低(P<0.05),无肾功能不全及过敏反应。结论在心肺转流手术中使用氨甲环酸可以明显减少术后出血量和输血量。

Aim To evaluate the efficiency and security of tranexamic acid in cardiac patients undergoing cardiopulmonary bypass.Methods 60 patients,scheduled for cardiopulmonary bypass were randomly divided into two groups with 30 patients in each group.In tranexamic acid group（group A）,patients received tranexamic acid（total dosage 90 mg·kg-1）,one half of total dosage was injected after induction of anesthesia,the remaining dosage was injected at a rate of 1.0 mg·kg-1·h-1 via microinfusion pump during intraoperation.In placebo group（group B）,patients acted as group A injected normal saline（total dosage 9 ml·kg-1）.The haematocrit（Hct）,platelet counts（Plt）and level of creatinine both prime and postoperation in two groups were recorded.The postoperative mediastinal chest tube drainage during 24 hours,blood product transfusions were all recorded,and the allergic reactions for all patients were observed.Results The postoperative mediastinal chest tube drainage during 24 hours and blood product transfusions were significantly more in group B than in group A（P 0.05）,and no adverse effects such as allergic reactions,renal dysfunction were observed in two groups.Conclusion The tranexamic acid was effective to reduce postoperative bleeding and blood product transfusions in cardiac patients undergoing cardiopulmonary bypass.